INSTRUCTIONS FOR COMPLETING APPLICATION AND AFFIDAVIT FOR PAYMENT OF UNCLAIMED FUNDS (revised 1/30/07)
A. Steps For Completing The Application 1. Enter the name of the case (name of the debtor) either to the right or under where In Re: is typed. Enter the case number. Enter the name of the person completing the application. Enter the amount being held by the Court in the unclaimed funds account. Enter the name of the creditor. This would be the same entry as in step #4 if the creditor is applying on behalf of his or her self. If the creditor is a company, enter the company's name as it appeared on it's proof of claim. If the company applying for unclaimed funds is not the same as the name originally filed, enter the name of the company applying. You will have to show proof as to why the new company or entity is entitled to the funds (see step #6 describing part 3 of the Affidavit of Creditor). Make an "X" or check mark for whichever choice is appropriate. Date. Name of creditor Signature of Applicant. Address, telephone number and last four digits of a social security number or complete tax identification number of the creditor. Claim number.
2. 3. 4. 5.
6. 7. 8. 9. 10
B. Steps For Completing The Affidavit 1. 2. Same as steps #1 thru #4 in instructions for application. Enter the name, position with the company if applicable, address and telephone number of the person signing the affidavit on page 2. Attach proof of creditor's right to the unclaimed funds as described in item #3 of the affidavit. Other examples of proof might be a copy of a driver's license, articles of incorporation, dissolution papers, copy of the proof of claim filed with the Court, etc.. If sufficient proof of the creditor's right to the funds is not provided, the application may be denied. The notarized signature of the person shown in step #5.
C. Steps For Completing the Proof of Service 1. 2. 3. 4. 5. Same steps as #1 and #2 in the instructions for application. The day a copy of the application was mailed to the U.S. Attorney. The applicant/creditor completing the application. The day the form was signed (if different form the date in item #2). The signature of the person mailing the application to the U.S. Attorney.
D. Steps for completing the Order For Payment Of Unclaimed Funds 1. 2. 3. 4. Same as steps #1 and #2 of the application. The written amount of funds payable. The numeric amount of funds payable. The payee is required to match what is shown on the W-9 form.
E. Steps for completing the W-9 form (required for payment) 1. Complete the form so that the name, address, and social security number
or tax identification of the payee matches the payee appearing on the Application and Order For Payment of Unclaimed Funds. Note: Applications completed by a representative of the payee will have checks made out to the payee and mailed in care of the representative.